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Impact of aspirin therapy in cancer patients with thrombocytopenia and acute coronary syndromes

  1. Mona G. Sarkiss MD, PhD1,
  2. S. Wamique Yusuf MBBS, MRCPI2,
  3. Carla L. Warneke MD3,
  4. Gregory Botz MD1,
  5. Nasser Lakkis MD4,
  6. Cheryl Hirch-Ginsburg MD5,
  7. J. Chris Champion MD2,
  8. Joseph Swafford MD2,
  9. Andrew D. S. Shaw MD6,
  10. Daniel J. Lenihan MD2,
  11. Jean-Bernard Durand MD2,†,‡,*

Article first published online: 13 DEC 2006

DOI: 10.1002/cncr.22434

Issue

Cancer

Cancer

Volume 109, Issue 3, pages 621–627, 1 February 2007

Additional Information

How to Cite

Sarkiss, M. G., Yusuf, S. W., Warneke, C. L., Botz, G., Lakkis, N., Hirch-Ginsburg, C., Champion, J. C., Swafford, J., Shaw, A. D. S., Lenihan, D. J. and Durand, J.-B. (2007), Impact of aspirin therapy in cancer patients with thrombocytopenia and acute coronary syndromes. Cancer, 109: 621–627. doi: 10.1002/cncr.22434

Author Information

  1. 1

    Departments of Anesthesiology and Critical Care, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  2. 2

    Department of Cardiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  3. 3

    Division of Quantitative Sciences, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  4. 4

    Department of Cardiology, Baylor College of Medicine, Ben Taub General Hospital, Houston, Texas

  5. 5

    Laboratory Medicine, University of Texas M. D. Anderson Cancer Center, Houston, Texas

  6. 6

    Department of Anesthesiology, Duke University, Raleigh, North Carolina

  1. †

    Dr. Jean-Bernard Durand is on the speaker's bureaus for Scios, GlaxoSmithKline, and Novartis.

  2. ‡

    Fax: (713) 745-1942

*Department of Cardiology, Unit 449, University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030

Publication History

  1. Issue published online: 19 JAN 2007
  2. Article first published online: 13 DEC 2006
  3. Manuscript Accepted: 11 NOV 2006
  4. Manuscript Revised: 9 OCT 2006
  5. Manuscript Received: 17 JUL 2006

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Keywords:

  • cancer;
  • thrombocytopenia;
  • acute coronary syndrome

Aspirin therapy in cancer patients with acute coronary syndrome significantly reduces mortality especially in the setting of thrombocytopenia, a new platelet paradox.

Abstract

BACKGROUND.

Patients with cancer who have thrombocytopenia may experience acute coronary syndromes (ACS), and the use of aspirin (ASA) poses an increased risk of bleeding. The purpose of this study was to test the hypothesis that the benefit of ASA therapy in the treatment of ACS would extend to cancer patients with thrombocytopenia and outweigh the risks of severe bleeding.

METHODS.

The records of all cancer patients diagnosed with an ACS in 2001 and referred for cardiology consultation were reviewed. Patients were divided into 2 groups on the basis of platelet count, >100 cells k/μL and ≤100 cells k/μL. Data were collected on the use of ASA therapy, bleeding complications, and survival rates. The authors assessed group differences by using the Wilcoxon rank sum test or 2-tailed Fisher exact test, as appropriate. Univariate and multivariate logistic regression models were used to assess factors potentially associated with 7-day survival.

RESULTS.

In cancer patients with ACS and thrombocytopenia, those who did not receive ASA had a 7-day survival rate of 6% compared with 90% in those who did receive ASA (P < .0001). There were no severe bleeding complications. Patients with a platelet count (>100 cells k/μL) who received ASA had a 7-day survival rate of 88% compared with 45% in those who did not receive ASA (P = .0096).

CONCLUSIONS.

Therapy with ASA was associated with a significantly improved 7-day survival after ACS in cancer patients, with or without thrombocytopenia, and not associated with more severe bleeding. Cancer 2007;109:621–627. © 2006 American Cancer Society.

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